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General NPI Number Information
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NPI Number | 1184933475
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Entity Type | Organization
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Legal Business Name | ELIZABETHTOWN COMMUNITY HOSPITAL
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Dates
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Enumeration Date | 10/04/2010
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 66 PARK STREET SUITE 100
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City | ELIZABETHTOWN
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State | NY
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Zip | 12832-0000
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Country | US
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Telephone | 518-873-2408
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 277
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City | ELIZABETHTOWN
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State | NY
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Zip | 12932-0277
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Country | US
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Telephone | 518-873-2408
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | WILLIAM DOHERTY
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Credential | PT
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Telephone | 518-873-2408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 032723-1
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License Number State | NY
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